NURS 215 - EXAM 3 - PREVIOUS YEAR'S BOOK (2 OF 3)
QUESTIONS WITH ACCURATE ANSWERS
1. A woman arrives at the clinic seeking confirmation that she is pregnant. The
following information is obtained: She is 24 years old with a body mass index
(BMI) of 17.5. She admits to having used cocaine several times during the past
year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg,
her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The
family history is positive for diabetes mellitus and cancer. Her sister recently gave
birth to an infant with a neural tube defect (NTD). Which characteristics place the
woman in a high risk category?
a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse correct answer ANS: D
Her family history of NTD, low BMI, and substance abuse all are high risk factors
of pregnancy. The womans BP is normal, and her age does not put her at risk. Her
BMI is low and may indicate poor nutritional status, which would be a high risk.
The womans drug/alcohol use and family history put her in a high risk category,
but her age does not. The womans family history puts her in a high risk category.
Her BMI is low and may indicate poor nutritional status, which would be high risk.
Her BP is normal.
1. In assessing the knowledge of a pregestational woman with type 1 diabetes
concerning changing insulin needs during pregnancy, the nurse recognizes that
further teaching is warranted when the client states:
a. I will need to increase my insulin dosage during the first 3 months of pregnancy.
,b. Insulin dosage will likely need to be increased during the second and third
trimesters.
c. Episodes of hypoglycemia are more likely to occur during the first 3 months.
d. Insulin needs should return to normal within 7 to 10 days after birth if I am
bottle-feeding. correct answer ANS: A
Insulin needs are reduced in the first trimester because of increased insulin
production by the pancreas and increased peripheral sensitivity to insulin. Insulin
dosage will likely need to be increased during the second and third trimesters,
Episodes of hypoglycemia are more likely to occur during the first 3 months, and
Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-
feeding are accurate statements and signify that the woman has understood the
teachings regarding control of her diabetes during pregnancy.
1. Women with hyperemesis gravidarum:
a. Are a majority, because 80% of all pregnant women suffer from it at some time.
b. Have vomiting severe and persistent enough to cause weight loss, dehydration,
and electrolyte imbalance.
c. Need intravenous (IV) fluid and nutrition for most of their pregnancy.
d. Often inspire similar, milder symptoms in their male partners and mothers.
correct answer ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment
for several days sets things right in most cases. Although 80% of pregnant women
experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe
level. IV administration may be used at first to restore fluid levels, but it is seldom
needed for very long. Women suffering from this condition want sympathy
because some authorities believe that difficult relationships with mothers and/or
partners may be the cause.
,2. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although
she has had irregular menstrual periods all her life. She has a history of smoking
approximately one pack of cigarettes a day, but she tells you that she is trying to
cut down. Her laboratory data are within normal limits. What diagnostic
technique could be used with this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
c. Amniocentesis
d. Nonstress test (NST) correct answer ANS: A
An ultrasound examination could be done to confirm the pregnancy and
determine the gestational age of the fetus. It is too early in the pregnancy to
perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed
at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are
abnormal or if fetal/maternal anomalies are detected. NST is performed to assess
fetal well-being in the third trimester.
2. Because pregnant women may need surgery during pregnancy, nurses should
be aware that:
a. The diagnosis of appendicitis may be difficult because the normal signs and
symptoms mimic some normal changes in pregnancy.
b. Rupture of the appendix is less likely in pregnant women because of the close
monitoring.
c. Surgery for intestinal obstructions should be delayed as long as possible
because it usually affects the pregnancy.
d. When pregnancy takes over, a woman is less likely to have ovarian problems
that require invasive responses. correct answer ANS: A
, Both appendicitis and pregnancy are linked with nausea, vomiting, and increased
white blood cell count. Rupture of the appendix is two to three times more likely
in pregnant women. Surgery to remove obstructions should be done right away. It
usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian
problems.
2. Preconception counseling is critical to the outcome of diabetic pregnancies
because poor glycemic control before and during early pregnancy is associated
with:
a. Frequent episodes of maternal hypoglycemia.
b. Congenital anomalies in the fetus.
c. Polyhydramnios.
d. Hyperemesis gravidarum. correct answer ANS: B
Preconception counseling is particularly important because strict metabolic
control before conception and in the early weeks of gestation is instrumental in
decreasing the risks of congenital anomalies. Frequent episodes of maternal
hypoglycemia may occur during the first trimester (not before conception) as a
result of hormone changes and the effects on insulin production and usage.
Hydramnios occurs about 10 times more often in diabetic pregnancies than in
nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events because the
decreased food intake by the mother and glucose transfer to the fetus contribute
to hypoglycemia.
3. In planning for the care of a 30-year-old woman with pregestational diabetes,
the nurse recognizes that the most important factor affecting pregnancy outcome
is the:
QUESTIONS WITH ACCURATE ANSWERS
1. A woman arrives at the clinic seeking confirmation that she is pregnant. The
following information is obtained: She is 24 years old with a body mass index
(BMI) of 17.5. She admits to having used cocaine several times during the past
year and drinks alcohol occasionally. Her blood pressure (BP) is 108/70 mm Hg,
her pulse rate is 72 beats/min, and her respiratory rate is 16 breaths/min. The
family history is positive for diabetes mellitus and cancer. Her sister recently gave
birth to an infant with a neural tube defect (NTD). Which characteristics place the
woman in a high risk category?
a. Blood pressure, age, BMI
b. Drug/alcohol use, age, family history
c. Family history, blood pressure, BMI
d. Family history, BMI, drug/alcohol abuse correct answer ANS: D
Her family history of NTD, low BMI, and substance abuse all are high risk factors
of pregnancy. The womans BP is normal, and her age does not put her at risk. Her
BMI is low and may indicate poor nutritional status, which would be a high risk.
The womans drug/alcohol use and family history put her in a high risk category,
but her age does not. The womans family history puts her in a high risk category.
Her BMI is low and may indicate poor nutritional status, which would be high risk.
Her BP is normal.
1. In assessing the knowledge of a pregestational woman with type 1 diabetes
concerning changing insulin needs during pregnancy, the nurse recognizes that
further teaching is warranted when the client states:
a. I will need to increase my insulin dosage during the first 3 months of pregnancy.
,b. Insulin dosage will likely need to be increased during the second and third
trimesters.
c. Episodes of hypoglycemia are more likely to occur during the first 3 months.
d. Insulin needs should return to normal within 7 to 10 days after birth if I am
bottle-feeding. correct answer ANS: A
Insulin needs are reduced in the first trimester because of increased insulin
production by the pancreas and increased peripheral sensitivity to insulin. Insulin
dosage will likely need to be increased during the second and third trimesters,
Episodes of hypoglycemia are more likely to occur during the first 3 months, and
Insulin needs should return to normal within 7 to 10 days after birth if I am bottle-
feeding are accurate statements and signify that the woman has understood the
teachings regarding control of her diabetes during pregnancy.
1. Women with hyperemesis gravidarum:
a. Are a majority, because 80% of all pregnant women suffer from it at some time.
b. Have vomiting severe and persistent enough to cause weight loss, dehydration,
and electrolyte imbalance.
c. Need intravenous (IV) fluid and nutrition for most of their pregnancy.
d. Often inspire similar, milder symptoms in their male partners and mothers.
correct answer ANS: B
Women with hyperemesis gravidarum have severe vomiting; however, treatment
for several days sets things right in most cases. Although 80% of pregnant women
experience nausea and vomiting, fewer than 1% (0.5%) proceed to this severe
level. IV administration may be used at first to restore fluid levels, but it is seldom
needed for very long. Women suffering from this condition want sympathy
because some authorities believe that difficult relationships with mothers and/or
partners may be the cause.
,2. A 39-year-old primigravida thinks that she is about 8 weeks pregnant, although
she has had irregular menstrual periods all her life. She has a history of smoking
approximately one pack of cigarettes a day, but she tells you that she is trying to
cut down. Her laboratory data are within normal limits. What diagnostic
technique could be used with this pregnant woman at this time?
a. Ultrasound examination
b. Maternal serum alpha-fetoprotein (MSAFP) screening
c. Amniocentesis
d. Nonstress test (NST) correct answer ANS: A
An ultrasound examination could be done to confirm the pregnancy and
determine the gestational age of the fetus. It is too early in the pregnancy to
perform MSAFP screening, amniocentesis, or NST. MSAFP screening is performed
at 16 to 18 weeks of gestation, followed by amniocentesis if MSAFP levels are
abnormal or if fetal/maternal anomalies are detected. NST is performed to assess
fetal well-being in the third trimester.
2. Because pregnant women may need surgery during pregnancy, nurses should
be aware that:
a. The diagnosis of appendicitis may be difficult because the normal signs and
symptoms mimic some normal changes in pregnancy.
b. Rupture of the appendix is less likely in pregnant women because of the close
monitoring.
c. Surgery for intestinal obstructions should be delayed as long as possible
because it usually affects the pregnancy.
d. When pregnancy takes over, a woman is less likely to have ovarian problems
that require invasive responses. correct answer ANS: A
, Both appendicitis and pregnancy are linked with nausea, vomiting, and increased
white blood cell count. Rupture of the appendix is two to three times more likely
in pregnant women. Surgery to remove obstructions should be done right away. It
usually does not affect the pregnancy. Pregnancy predisposes a woman to ovarian
problems.
2. Preconception counseling is critical to the outcome of diabetic pregnancies
because poor glycemic control before and during early pregnancy is associated
with:
a. Frequent episodes of maternal hypoglycemia.
b. Congenital anomalies in the fetus.
c. Polyhydramnios.
d. Hyperemesis gravidarum. correct answer ANS: B
Preconception counseling is particularly important because strict metabolic
control before conception and in the early weeks of gestation is instrumental in
decreasing the risks of congenital anomalies. Frequent episodes of maternal
hypoglycemia may occur during the first trimester (not before conception) as a
result of hormone changes and the effects on insulin production and usage.
Hydramnios occurs about 10 times more often in diabetic pregnancies than in
nondiabetic pregnancies. Typically it is seen in the third trimester of pregnancy.
Hyperemesis gravidarum may exacerbate hypoglycemic events because the
decreased food intake by the mother and glucose transfer to the fetus contribute
to hypoglycemia.
3. In planning for the care of a 30-year-old woman with pregestational diabetes,
the nurse recognizes that the most important factor affecting pregnancy outcome
is the:
